Healthcare Provider Details

I. General information

NPI: 1386969137
Provider Name (Legal Business Name): JOHN DEVIN BLACKWELL WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

2 SCHOONER LN
OCEAN SPRINGS MS
39564-5049
US

V. Phone/Fax

Practice location:
  • Phone: 702-460-1720
  • Fax:
Mailing address:
  • Phone: 210-238-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101251335
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101251335
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number28756
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: